Provider Demographics
NPI:1407805633
Name:BLUEFIELD REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:BLUEFIELD REGIONAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR REV MANAGEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-325-1991
Mailing Address - Street 1:500 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-3306
Mailing Address - Country:US
Mailing Address - Phone:304-327-1100
Mailing Address - Fax:304-324-2628
Practice Address - Street 1:500 CHERRY ST
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701
Practice Address - Country:US
Practice Address - Phone:304-327-1100
Practice Address - Fax:304-324-2628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-06
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV00012090003Medicaid
VA007610581Medicaid
CG0100OtherPALMETTO GBA MEDICARE PAR
WV0001209004Medicaid
VA009818707Medicaid
000301718OtherMOUNTAIN STATE BLUE CROSS
WV0001209000Medicaid
030017500OtherDEPT OF LABOR
5100711OtherPALMETTO GBA MEDICARE PAR
WV0001209000Medicaid